RESUMEN

OBJECTIVES: The main objective of the study was to describe and compare the feasibility of using fractional CO2 laser to the usual treatment with Clobetasol. Randomized clinical trials brought together 20 women from a Brazilian university hospital, 9 of them were submitted to Clobetasol treatment and 11 to laser therapy. Sociodemographic data were obtained and quality of life parameters, vulvar anatomy, self-perception and histopathological analysis of vulvar biopsies were evaluated. Evaluations were made before the beginning of the treatment, during its implementation, right after its completion (3 months), and 12 months after. The SPSS 14.0 software was used, obtaining descriptive measurements. The level of significance adopted was 5%. RESULTS: The clinical/anatomical characteristics of the vulva did not differ between the treatment groups, as much before as after its performance. There was no statistically significant difference between the treatments performed regarding the impact on the life quality of the patients. A higher satisfaction degree with the treatment was obtained with the patients in the Laser group in the third month of evaluation. Laser therapy also revealed higher occurrence of telangiectasia after treatment completion. Fractional CO2 laser has proven to be well accepted and is a promising therapeutic option. Registration number and name of trial registry The institutional review board status was approved by the Research Ethics Committee of HU/ UFJF under advisory number 2881073 and registered in the Brazilian Clinical Trials, with consent under registration RBR-4p9s5y. Access link: https://ensaiosclinicos.gov.br/rg/RBR-4p9s5y.

Asunto(s)

RESUMEN

Introdução: O Exame Clínico Objetivo Estruturado é um dos métodos mais eficazes de avaliação do processo de aprendizagem, pois analisa o desempenho do participante em uma tarefa clínica especifica. Objetivo: Apresentar a vivência do serviço de Ginecologia sobre a elaboração e execução de uma estação do exame desenvolvido por uma universidade, promovendo uma reflexão sobre o processo de ensino aprendizagem dos alunos desta instituição. Relato de Experiência: O planejamento e organização demandaram um período de 4 meses, com definição do local, comissão de apoio técnico, elaboração dos casos clínicos e das competências a serem avaliadas, materiais disponíveis (impressos, canetas, móveis, dentre outros). Os professores elaboradores das estações foram previamente treinados pela comissão organizadora e orientados a formularem uma estação com caso clínico compatível com o momento do aluno no curso de Medicina. Outro instrumento elaborado foi o checklist, com pontos fundamentais que deveriam ser cumpridos pelo estudante avaliado. Após elaboração da estação e do seu checklist, estes foram avaliados pela comissão organizadora, com realização das correções pertinentes. Após aprovação, os professores, tanto elaboradores quanto avaliadores, realizaram a simulação da estação para identificação de possíveis erros, fatores complicadores e para cronometragem do tempo. Conclusão: O método desenvolvido apresentou características de grande importância e destaque, bem como fragilidades que precisam ser resolvidas.

Introduction: The Objective Structured Clinical Examination is one of the most effective methods of evaluating the learning process, as it analyzes the participant's performance in a specific clinical task. Objective: To present the experience of the Gynecology service on the preparation and execution of an exam station developed by a university, promoting a reflection on the teaching-learning process of students at this institution. Experience Report: Planning and organization required a period of 4 months, with definition of the location, technical support committee, preparation of clinical cases and skills to be evaluated, available materials (prints, pens, furniture, among others). The teachers who created the stations were previously trained by the organizing committee and instructed to formulate a station with a clinical case compatible with the student's current time in the Medicine course. Another instrument created was the checklist, with fundamental points that should be fulfilled by the student assessed. After preparing the station and its checklist, they were evaluated by the organizing committee, with relevant corrections made. After approval, the teachers, both developers and evaluators, carried out the station simulation to identify possible errors, complicating factors and to measure time. Conclusion: The developed method presented characteristics of great importance and prominence, as well as weaknesses that need to be.

RESUMEN

The mass are among the possible alterations observed in the axilla. When found, the most frequent differential diagnosis are lymphadenopathy, metastatic lymphadenomegaly, lymphoma, lipoma or tumors in the apocrine glands. Besides that, the presence of accessory breast tissue must also be considered and, as the topical breast tissue, can be the target of breast diseases, either benign or malignant. Female patient, 23 years old, with the presence of hardened palpable node in the right axilla. At the ultrasound, it presented characteristics that classified it as Bi-Rads® 4. An aspiration biopsy of the node was performed with fine-needle, which resulted in unsatisfying material. After the explanation of the therapeutic choices, the patient opted for the excision of the axillary node. The anatomical pathological result showed a nodular formation compatible with fibroadenoma. The occurrence of a node in the axillary region is common. However, in the vast majority of times, it is merely an inflammatory response, manifested as a lymphadenomegaly. In case of chronic mass with suspicious characteristics, it is convenient to suspect the presence of lymphoid neoplasms, locoregional metastasis of breast cancer or melanoma and alterations in accessory breast tissue. In young patients, it is important to evaluate the existence of accessory breast tissue with the presence of suspicious axillary node, because, although controversial, some authors believe that such alterations occur more frequently in these patients. Additionally, in cases of inconclusive imaging, an excision of the lesion must be performed for a definite diagnosis.

RESUMEN

Introdução: A doença tromboembólica venosa e as complicações obstétricas resultantes do tromboembolismo placentário são as principais causas de morbidade e mortalidade materna e fetal. Pode-se dizer que a gravidez é um fator independente para o desenvolvimento de trombose, já que seu risco é de 5 a 6 vezes maior em mulheres grávidas quando comparadas a não grávidas, sendo mais elevado após o parto. Métodos: Trata-se de uma coorte histórica, onde foram estudadas pacientes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora (expostos=n=70 pacientes) e na Faculdade de Medicina de Barbacena (não expostos=n=74 pacientes). As pacientes foram divididas em dois grupos: Grupo 1 = pacientes com alguma trombofilia identificada (expostos) através das dosagens de proteína S, proteína C, homocisteína, antitrombina III, mutação da MTHFR, mutação da protrombina e do fator V de Leiden; e Grupo 2 = pacientes do serviço de baixo risco obstétrico. Resultados: Houve associação entre trombofilia e aborto prévio, bem como trombofilia e morte fetal prévia (p<0,05). O tipo de trombofilia que foi associada a abortamento prévio foi o déficit da proteína S. A mutação da MTHFR foi associada aos antecedentes de HELLP síndrome (p=0,03; x2 =4,2) e de pré-eclâmpsia (p=0,03; X2 =4,5) quando em homozigotia mutante. A homozigotia para a MTHFR foi também associada às médias de homocisteína, de forma que as homozigotas eram aquelas que apresentavam a maior dosagem de homocisteína (p=0,01; X2 =5,8; X= 27,2 ± 41,2 vs. 12,62 ± 19,0). Conclusão: As trombofilias hereditárias podem estar associadas a mau desfecho obstétrico e devem ser valorizadas na clínica obstétrica. (AU)

Introduction: Venous thromboembolic disease and obstetric complications resulting from placental thromboembolism are the main causes of maternal and fetal morbidity and mortality. Pregnancy is considered an independent factor for the development of thrombosis, as its risk is 5 to 6 times greater in pregnant women when compared to non-pregnant women, being even higher after childbirth. Methods: This historical cohort included patients seen at the Obstetrics Service of Federal University of Juiz de Fora (exposed patients, n = 70) and at the School of Medicine of Barbacena (unexposed patients, n = 74). The patients were divided into two groups: Group 1 consisted of patients with some thrombophilia identified through measurement of protein S, protein C, homocysteine, antithrombin III, MTHFR mutation, prothrombin and factor V Leiden mutations; and Group 2 consisted of patients from the low obstetric risk service. Results: There was an association between thrombophilia and previous abortion, as well as thrombophilia and previous fetal death (p < 0.05). MTHFR mutation was associated with history of HELLP syndrome (p = 0.03; x2 = 4.2) and preeclampsia (p = 0.03; x2 = 4.5) when in homozygous mutation. Homozygous MTHFR was also associated with mean homocysteine levels, so that homozygotes were those with highest homocysteine levels (p = 0.01; x2 = 5.8; x = 27.2 ± 41.2 vs. 12.62 ± 19.0). Conclusions: Hereditary thrombophilias may be associated with poor obstetric outcome and should be valued at clinical obstetrics. (AU)

Asunto(s)

RESUMEN

Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. The occurrence of endometriosis in the anterior abdominal wall is often associated with previous cesarean section, once the spread of endometrial cells during the surgical procedure is a biologically fact possible. A 43-year-old patient, with cesarean section history and pelvic endometriosis diagnosed for over 10 years, presented with progressive abdominal pain. Tests showed cystic image with 1.6 cm of diameter and debris, located in mid-lower portion of the rectus abdominis left, suggesting abdominal wall endometriosis. This abdominal wall lesion was not identifiable in the clinical examination (impalpable), which is why we opted for the use of preoperative marking technique with radioisotope called Radioguided Occult Lesion Localization (ROLL™). The use of ROLL™ in this case allowed rapid surgical identification of endometriotic lesion and its complete excision.

RESUMEN

RESUMO O prontuário do paciente constitui uma ferramenta fundamental para a prestação do cuidado em saúde, podendo ser definido como um registro padronizado e organizado de toda a informação referente à saúde de um indivíduo, desde o nascimento até a morte. Na década de 1970, impulsionados pelo crescente desenvolvimento da tecnologia, surgem os primeiros sistemas de Prontuários Eletrônicos do Paciente (PEP), sob uma proposta de informatização dos registros em saúde. Por meio de uma criteriosa pesquisa bibliográfica, questões concernentes ao prontuário eletrônico do paciente foram discutidas, especialmente do ponto de vista ético. Os avanços tecnológicos aplicados à área de saúde devem ser implantados de maneira crítica, em que pesem as consequências imprevistas que possam ter quanto à relação médico-paciente, uma vez que o cuidado e o respeito devem ser prioridade, e não os interesses particulares. Por isso, uma análise apenas técnica não abarca elementos que podem ser compreendidos à luz dos conceitos éticos, os quais norteiam escolhas baseadas no interesse comum.

ABSTRACT Electronic Medical Records serve as a fundamental tool in the healthcare service and may be defined as standardized and organized records featuring all the information on a patient’s medical history since birth. Due to technological developments, the first Electronic Medical Records were created in the 1970s in order to computerize records in the healthcare field. Bibliographical research was carried out in order to discuss aspects of electronic medical records, especially concerning their ethical dimensions. Technological improvements should be considered in a more critical way, since there may be unforeseen consequences related to their use, especially related to the doctor-patient relationship. Despite technology’s importance in improving healthcare services, care and respect should always be of priority and personal interests should be avoided. An analysis that highlights only the technical aspects of Electronic Medical Records is therefore insufficient to answer all the questions that might arise, with ethical concepts perhaps playing a role in answering such questions.

Asunto(s)

RESUMEN

O número de casos clandestinos de aborto provocado tem aumentado ao longo dos anos no Brasil. Regulamentada pelo Código Penal Brasileiro, a lei sobre aborto sofreu alterações pelo Supremo Tribunal Federal em 2012, ocasião em que o aborto de fetos anencéfalos se tornou legal. Por isso discutir o assunto é importante, visto que é um grande problema de saúde pública e traz graves prejuízos à vida da mulher. O objetivo do presente trabalho foi captar a percepção e o conhecimento da população a respeito desta prática e da decisão do Supremo Tribunal Federal. Como método foi utilizado um estudo transversal, quantitativo, realizado através de entrevista com homens e mulheres da cidade de Juiz de Fora - Minas Gerais, Brasil. Constatou-se que o nível de conhecimento sobre as indicações de aborto legal no Brasil é baixo, principalmente após a mudança da lei. Embora haja desconhecimento sobre o tema, a maioria dos entrevistados apoiaria o uso deste atributo diante de um dos três casos de indicação de aborto legal (em caso de estupro, feto anencéfalo e risco de vida da gestante). Por fim, também foi observado que níveis maiores de estudo e renda são determinantes para praticar ou apoiar o aborto ilegal, assim como crenças religiosas atuam como inibidoras desta prática na amostra geral.

Asunto(s)